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Individual

TIMOTHY WILLIAM SCHACKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
516 DELAWARE ST SE, PWB SIXTH FLOOR, CLINIC 6B, MINNEAPOLIS, MN 55455-0356
(612) 625-4680
Mailing address
420 DELAWARE STREET SE, UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 625-4680

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39425
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1012177
PREFERRED ONE
MN
05
102020000
MN
01
115288
UCARE
MN
01
34Y72SC
BLUE CROSS BLUE SHIELD
MN
01
603758
ARAZ
MN
01
92-00024
MEDICA CHOICE
MN
01
92-70159
MEDICA PRIMARY
MN
01
HP22105
HEALTH PARTNERS
FM
Enumeration date
10/20/2006
Last updated
07/08/2007
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